Reusable Frame for Pedicle Protection in Heel and Ankle Defects

Abstract

Introduction: It has always been a challenging task for the reconstructive surgeons to resurface the lost skin and soft tissue over the heel. This is done by use of skin grafts, local flap or microvascular free flap (MFF). The postoperative care and splintage of these limbs is a difficult task, and often the success or failure of the flap will depend on proper postoperative splintage and positioning of the operated limb. A simple and reusable frame is being described for pedicle protection in flap surgery for posterior heel and ankle wounds. Aims and objective:To devise a reusable frame for pedicle protection in heel and ankle defects. Materials and methods:A reusable frame splint designed by holding up the foot against gravity at a narrower circumference of forefoot just proximal to the wider circumference of the foot at the metatar sophalangeal joint (MTP) level. This frame was used in the early postoperative period for positioning the lower limb in patients undergoing surgery for coverage of posterior heel defects.Result: A total of 14 patients underwent wound coverage of post heel defect over a period of 3 years. Out of these 14 patients, nine had reverse sural artery pedicle flap, three had splitthickness skin grafting and remaining two had MFF done. In all the cases, a specially designed frame was used for pedicle protection. One patient had developed erosion and blistering, which healed subsequently. Conclusion:This innovation in the splint helps in providing adequate elevation of limb and protection of pedicle of local or MFF used for coverage of heel and ankle defects.